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Based on interview, policy, and record review, the facility failed to ensure that 2 of 3 current patients with diagnoses of Diabetes Mellitus and orders for CCHO (consistent carbohydrate) diets (patients #9-#11) received that diet. Findings include:

Policy:
DS-1-001, titled "Patient Food Service- Diet Order," states:
III. Procedure
A. New Admissions:
1. Upon admission, a physician diet order is received for the patient.
2. This diet is recorded on a diet order and communication form and delivered from Nursing to Food Service.
3. Food Service prepares meals as per physician order.
B. Diet Changes:
4. Food Service prepares meals as ordered by the physician.
Observations:
1. On 8/27/12 from 12 noon- 12:20 pm patients on the A and B units were observed eating lunch. Staff present during lunch were unable to provide diet slips/tickets indicating patient name and diet ordered for all patients. On Unit A, only one diet slip was available for review. It was not possible to verify that all patients with orders for special diets received diets as ordered through direct observation without diet slips on hand during lunch.
2. The above findings were verified by the DON (Director of Nursing) in dining rooms on units A and B from 12 noon-12:20 pm.
Patient Record Review:
1. On 8/27/12 at approximately 11 am, record review revealed that 3 current patients (#9-#11) with diagnoses of Diabetes Mellitus had current physician orders for CCHO (controlled carbohydrate) diets.
2. On 8/27/12 from 2:55-3:15 pm diet slips for patients #9-#11, prepared by kitchen staff and listing individual patient diets, were reviewed with RD (Registered Dietitian) #1. Patients #9-#11 had orders for CCHO diets but these orders were not listed on their meal slips.
Interviews:
1. On 8/27/12 at approximately 1 pm RD (Registered Dietitian) #1 stated that CCHO stands for "consistent carbohydrate diet" and that a book titled "Simplified Diet Manual" by the Iowa Dietetic Association, contains the facility's special diets and dietary policies. The book lists CCHO under "Diets for Diabetes."
2. On 8/27/12 at 11 am the Dietary Logs for units A and B were reviewed with RD #1. RD #1 verified that patients # 9-#11 were listed as having orders for CCHO diets on the Logs.
3. On 8/27/12 from 3:00-3:15 pm RD #1 and this Surveyor met with Cook #1 in kitchen where patient meals are prepared. Cook #1 stated that she is currently responsible for transferring patient's diet orders from "Diet Order & Communications" notes sent by the facility to individual diet slips, placed on patient trays. Cook #1 stated that she does not enter CCHO orders on to diet slips since that is not a diet type that the kitchen provides. Cook #1 stated that she makes no entry when she sees this order.
4. On 8/27/12 at 3:15 pm RD #2, employed by the company contracted to prepare meals for facility patients, provided a list of the 6 diets that the kitchen prepares. CCHO was not listed. RD #2 stated that RSD (Restricted Sweets Diet) is the type of diet that the kitchen uses in preparing diabetic diets, not CCHO.
5. On 8/27/12 at 4:45 pm CCHO orders for 3 patients (#9-#11) were reviewed with the DON(Director of Nursing). Meal slips obtained from the kitchen, containing no notation of CCHO or RSD diets for patients #9-#11 were also reviewed with the DON.

Based on observation, interview, and record review, the facility failed to ensure that kitchen staff who transfer patient diet orders to meal slips and prepare individual trays had a copy of the facility's dietary manual available in the kitchen area. Findings include:

Observations:
1. On 8/27/12 from 3-3:15 pm the facility's kitchen was toured. The kitchen is located on the first floor and has a contract with the provider to prepare patient meals. The facility is located on the 3rd floor of the same building.
2. A copy of the facility's dietary manual was not available in the kitchen area during the tour.
Interviews:
1. On 8/27/12 at approximately 1 pm RD #1 stated that a book titled "Simplified Diet Manual," by the Iowa Dietetic Association, contains the facility's special diets and dietary policies. The book was signed by the Registered Dietitian, Chief of the Medical Staff and Chief Operating Officer.
2. On 8/27/12 RD #1 and Cook #1 stated that patient meals are prepared in a kitchen located on the 1st floor of the building where the facility is located, on the 3rd floor. Cook #1 stated that she receives diet orders from the facility and types the orders on to meal slips that accompany patient trays.
3. On 8/27/12 at approximately 3:15 pm, during a tour of the kitchen, Cook #1 stated that she did not know of a copy of the facility's dietary policy manual ("Simplified Diet Manual") in the kitchen area. Cook #1 did not respond when asked how the kitchen ensures that diets are prepared in accordance with the facility's diet manual.